A Review of the Diagnosis and Management of Index through Fifth Carpometacarpal Dislocations

Traumatic dislocations of the second (index) to the fifth (little finger) carpometacarpal (CMC) joints are uncommon injuries accounting for less than 1% of all hand injuries [1]. These injuries often elude the unsuspecting attending clinician with as many as 70% of dislocations being missed completely or misdiagnosed at initial presentation [2]. Inexperienced practitioners right through to experienced orthopaedic surgeons can miss these injuries unless care is taken to get a history, examine the patient and to evaluate the radiographs diligently [2]. A high index of suspicion based on energy of precipitating trauma through to physical findings is of essence in reaching an accurate diagnosis. There is general consensus on the difficulty of diagnosing this injury whilst acknowledging the excellent prognosis of such injuries when treated early [3]. As many as 4 out of 10 patients with a CMC dislocation that has been missed or misdiagnosed will experience chronic pain and/or impaired function [1]. With early appropriate management however, full return to gainful employment and sports is to be expected in almost 9 out of 10 of patients with CMC joint injuries [1]. As the motion at the CMC joints is crucial for grasping and palmar cupping in normal hand functioning, it follows that the restoration of the articular function of these joints after dislocations is critical for normal hand function.